Atherosclerotic Cardiovascular Disease (CVD) is today the leading cause of early death worldwide, affecting both men and women; all deaths in Europe before the age of 75, 42% women and 38% men, are due to CVD.
It is important that cardiovascular risk be evaluated continuously throughout one’s life, as both risk and prevention are elements that change continuously and that evolve with the patient’s age and/or with accumulated comorbidities.
Risk factors have been identified for a long time, but the truth is that the results remain far from desirable. In table 1, we present in a transversal way the risk factors, as well as the objectives for their control or eradication. These objectives were issued by the international medical societies linked to this problem.
TABLE 1 – RISK FACTORS AND AIMS TO CONTROL CVD
|Factor//Target||Objectives / Aim|
|Smoking||Prohibited exposure to tobacco in any form.|
|Physical activity (PA)||At least 150 minutes per week of moderate aerobic PA (30 minutes 5 days/week) or 75 minutes per week of intense aerobic PA (15 minutes 5 days/week) or a combination of both.|
|Body weight||20 – 25 kg/m2 of BMI. Waist circumference
< 94 cm (men) or < 80 cm (women)
|Blood pressure||< 140/90 mmHg|
|LDL is the primary target (low-density lipoprotein cholesterol)||Very high risk: < 70 mg/dL or a reduction of at least 50% if baseline is between 70 and 135 mg/dL|
|HDL-C||No target but > 40 mg/dL in men and > 45 mg/dL in women indicate lower risk|
|Triglycerides||No target, but values < 150 mg/dL indicate a lower risk and higher values indicate a need to look for other risk factors.|
|Diabetes||HbA1c (glycosylated haemoglobin) < 7% (< 53 mmol/mol)|
|NB. The values presented are generic, and there may be a need to adjust them for certain groups, such as the elderly, patients with diabetes mellitus or patients with chronic kidney disease.|
As far as risk monitoring of cardiovascular disease in specific population groups, international organisations draw attention to the following groups that require specific follow-up and medication protocols:
Patients who survive cancer after chemotherapy or radiotherapy are at increased risk of CVD;
The increased incidence of CVD is correlated with the (combination of) treatment performed and the dose administered;
The presence of traditional CV risk factors in cancer patients further increases CV risk.
Rheumatoid arthritis potentiates CV risk independently of traditional risk factors;
There is growing evidence that other immune diseases such as ankylosing spondylitis or early-onset of severe psoriasis also increase CV risk.
Obstructive sleep apnoea syndrome
There is evidence of a positive relationship between obstructive sleep apnoea syndrome and hypertension, cardiovascular disease, atrial fibrillation, stroke and heart failure.
Erectile dysfunction is associated with future cardiovascular episodes in men with and without established cardiovascular disease.
Article submitted by the HPA Group